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. 2017 Oct;37(10):1108-1111.
doi: 10.1038/jp.2017.101. Epub 2017 Jul 6.

A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic

S Loudin  1 , J Werthammer  1 , L Prunty  2 , S Murray  3 , J I Shapiro  4 , T H Davies  5
Affiliations

A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic

S Loudin et al. J Perinatol. 2017 Oct.

Abstract

Objective: The purpose of this study was to test a specialized needs-based management model for a high volume of babies born with neonatal abstinence syndrome (NAS) while controlling costs and reducing neonatal intensive care unit (NICU) bed usage.

Study design: Data were analyzed from inborn neonates >35 weeks' gestational age with the diagnosis of NAS (ICD9-CM 779.5), requiring pharmacologic treatment and discharged from 2010 through 2015. Significance was determined using Kruskal-Wallis and Mann-Whitney as well as χ2 for trend.

Results: NAS requiring medication treatment increased from 34.1 per 1000 live births in 2010 to 94.3 per 1000 live births in 2015 (P<0.0001 for trend). Hospital charges were significantly different in the three described locations (P<0.0001). Median per patient hospital charges for medically treated NAS were $90 601 (interquartile range (IQR) $64 489 to $128 135) for NAS patients managed in the NICU, $68 750 (IQR $44 952 to $92 548) for those managed in an in-hospital dedicated unit and $17 688 (IQR $9933 to $20 033) for those cared for in an outpatient neonatal withdrawal center. NICU admission was avoided in 78% of the population once both alternative locations were fully implemented.

Conclusions: In this cohort of infants, a 219% increase in the number of infants treated for NAS overwhelmed the capacity of our traditional resources. There was a need to develop new treatment approaches dealing with the NAS crisis and a growing population of prenatally exposed babies. We found that the described model of care significantly reduced charges and stabilized admissions to our NICU despite the marked increase in cases. Without this system, our NICU would be in a critical state of gridlock and diversion; instead, we have efficient management of a large NAS population.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
NAS incidence per 1000 live births at Cabell Huntington Hospital (CHH). Neonates with proven prenatal exposure to neuroactive substances and neonates pharmacologically treated with methadone diagnosed with NAS per 1000 live births per year. Trend is significant as determined by χ2-test for trend (P<0.0001). West Virginia (WV) NAS diagnoses are as reported in the literature for comparison. WV counts of NAS not available for 2014 to 2015. NAS, neonatal abstinence syndrome.
Figure 2
Figure 2
Distribution of NAS patients admitted to individual treatment units. Distribution of the number of patients admitted to individual units NICU, NTU or Lily’s Place per year. NAS, neonatal abstinence syndrome; NICU, neonatal intensive care unit; NTU, neonatal therapeutic unit.
Figure 3
Figure 3
Charge distribution for NAS patients in different units. Median charge per patient (5 to 95%). Significance for hospital charges per patient was determined using Kruskal–Wallis test (P<0.0001). Mann–Whitney was used to test significance between charges for individual units (NICU vs NTU: P<0.0001), (NTU vs Lily’s Place: P<0.0001) and (NICU vs Lily’s Place: P<0.0001). NAS, neonatal abstinence syndrome; NICU, neonatal intensive care unit; NTU, neonatal therapeutic unit.
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